Provider Demographics
NPI:1164769253
Name:GASSER, KEVIN L (DDS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:L
Last Name:GASSER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17220 N BOSWELL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-2000
Mailing Address - Country:US
Mailing Address - Phone:623-972-8217
Mailing Address - Fax:623-972-1406
Practice Address - Street 1:17220 N BOSWELL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-2000
Practice Address - Country:US
Practice Address - Phone:623-972-8217
Practice Address - Fax:623-972-1406
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2014-12-03
Deactivation Date:2013-07-01
Deactivation Code:
Reactivation Date:2013-10-31
Provider Licenses
StateLicense IDTaxonomies
PABG01953661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice